It is said that a thousand-mile journey begins with a single small step. There are many examples of small hospitals that have become prominent and influential healthcare institutions, pointing toward the possibilities of remarkable growth even when starting from humble origins. The Ruby Hall Clinic in Pune is a case in point—from a 4-bed nursing home in 1959 to today being a major multi-speciality hospital with over 600 beds. Aster DM Healthcare was started as a small hospital in Kerala but has now evolved into a global conglomerate in Healthcare. Shalby Hospitals started in Ahmedabad as a centre for joint replacement but expanded into a multi-speciality chain. The Asian Institute of Medical Sciences (AIMS) in Faridabad, Paras Hospitals in Gurgaon, and Kauvery Hospital in Trichy have all replicated the model. These are the very examples underlining how starting a minor in the health sector of India and scaling up can be a reality with quality care, specialisation, and expansion at its core.
Small hospitals in smaller cities have recently shown that size isn’t everything. The recent accomplishment of MapleHospital—a 25-bed cardiac hospital in Bharuch, Gujarat—epitomises the emerging trend: single-specialty hospitals run by doctors themselves are making it big in the healthcare market. This can be exemplified by the recent initial public offering for Maple Hospital, which managed to raise ₹4.02 crore at a valuation of ₹15.2 crore: the smallest IPO in India. In addition, this IPO was oversubscribed by a whopping 356 times and closed with a premium of 90% on the first listing day.
This is an incredible achievement, but it beckons the question: Is this the real dawn of a new era for small, single-specialty, doctor-managed hospitals?
The MapleHospital Success Story
Maple Hospital’s success is not a solitary experience but a precursor to a new trend that has been changing the healthcare landscape in India. Established by 38-year-old cardiologist Dr. Jaykumar Vyas, Maple Hospital began humbly as a 25-bed hospital in Bharuch with a 15-bed satellite hospital in Ankaleshwar. The hospital exclusively caters to cardiac cases and related treatments, providing ECG, coronary angiography, angioplasty, pacemaker implantation, and cardiology PACS laboratory services.
The most remarkable thing about Maple Hospital is its strong financial performance. Withstanding the heat of the COVID-19 pandemic, the hospital has been continuously delivering in terms of revenues and profits. In FY24, the hospital witnessed revenue amounting to ₹3.23 crore; since FY21, the revenues were always robust despite fluctuations. Profitability at the hospital is no less than impressive, with profit margins ranging from 7.73% to 26.24% in this period.
Key investor metrics further underline the hospital’s attraction. With a P/E ratio of 13.02 and ROCE of 17.09%, Maple Hospital has caught the eye of investors, especially in this era when ventures like Nephrocare India have proved that they could be very lucrative investments. Return on Capital Price-to-Earnings (P/E) ratio is a financial metric used to evaluate the valuation of a company’s stock. Employed (ROCE) is a financial metric that measures a company’s profitability and the efficiency with which it uses its capital
A Broader Trend in small Healthcare facilities
A similar successful story is in the life of Nephrocare India, a doctor-run chain of kidney hospitals based in Kolkata. Just a month before Maple Hospital’s IPO, Nephrocare India raised ₹41.26 crore and was oversubscribed an astounding 715 times. These successes underline a meaningful pivot happening in the healthcare sector, where small, specialized hospitals in small cities are attracting critical investor interest and stepping into significant financial milestones.
These developments are not entirely surprising. After all, some of India’s largest and most successful healthcare brands historically have sprung out of small cities. For example, the largest IVF brand in the country today is the Indira IVF Group from Udaipur, Rajasthan, which received significant private equity backing from firms such as TA Associates and BPEA (American based Equity firms). Similarly, Dr. Agarwal’s Eye Hospital, a 1957-founded brand, has raised over $125 million from global investors like TPG and Temasek.
These examples point to a key lesson for aspiring healthcare entrepreneurs: starting small in a small city can be very effective. With lower operational costs, less competition, and growing demand for specialized services, small towns offer fertile ground for single-specialty hospitals to flourish.
The Strategic Roadmap for Success
The path to successfully opening a hospital is becoming more apparent for doctors. The first step would be to establish a single-specialty hospital in a small city. This would allow you to keep the service focus much sharper and thus help manage operational costs to lower levels.
If an opening is in a small city, the land should be personally owned and leased to one’s private limited company instead of renting to external parties. This will help ease the high-cost structure of small cities and avoid intense competition. Another aspect is opening satellite hospitals in neighbouring smaller towns so that domestic medical tourism can occur, making the reach for the hospital much larger with higher revenue potential.
The focus should be on empanelling with Public Sector Undertakings, Yashaswini Scheme and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, also known as ABPMJAY, because the patients are huge in numbers and both provide a guaranteed income. Of course, NRI patients would be willing to undergo quality treatment in India. Beyond this, no big marketing would be required, as the reputation and word of mouth in the medical community usually suffice to bring in the local patient base.
The Success of Maple Hospital and Nephrocare India: The Future of Small Hospitals
The success of Maple Hospital and Nephrocare India goes to show that there is huge potential for small hospitals in small cities/towns, provided they are managed by doctors and run professionally. As healthcare costs in Tier-1 cities continue to rise and competition intensifies, small cities/towns present a viable alternative for healthcare entrepreneurs looking to make a significant impact. “With the right strategy, small hospitals could grow into major healthcare providers akin to Narayana Super Speciality Hospitals, Kauvery Hospital, and Metro Hospitals & Heart Institutes”.
Summary:
The era of small city/town, single-specialty, doctor-run hospitals is indeed upon us. The success of ventures like MapleHospital is not just a flash in the pan but a sign of things to come. The roadmap is clear for doctors’ entrepreneurial ambitions. With the enormous growth potential, as such small hospitals create their footprint, they will play the most critical role in shaping the future of Healthcare in India, thereby proving that today’s small hospitals are indeed tomorrow’s big brands.
Dr. Prahlada N. B
MBBS (JJMMC), MS (PGIMER, Chandigarh).
MBA (BITS, Pilani), MHA,
Executive Programme in Strategic Management (IIM, Lucknow)
Senior Management Programme in Healthcare Management (IIM, Kozhikode)
Postgraduate Certificate in Technology Leadership and Innovation (MIT, USA)
Advanced Certificate in AI for Digital Health and Imaging Program (IISc, Bengaluru).
Dear sir ,i feel happy to read ur blogs n try to understand them ,how about starting a hospital in a rural area of single speciality it is of 13000 popn with accessible to nearly 10 villages but also near to big town where all type of specialities with good services present hardly 17 kms from this place .is it sensible to start or no pls guide
ReplyWell said Prahlada Sir,
"Small hospitals are like tiny sparks that collectively ignite a beacon of hope, illuminating the healthcare landscape of India. They are the unsung heroes, quietly serving the community, and making a significant impact.
Like a delicate thread, small hospitals weave together the fabric of healthcare, stitching together the gaps in medical services, and providing a safety net for the vulnerable.
These tiny titans of healthcare are like a small but mighty army, fighting against the odds, and conquering the challenges of limited resources, and infrastructure.
With every patient treated, every life saved, and every smile restored, small hospitals prove that even the smallest drop can create a ripple effect, transforming the ocean of healthcare in India.
They are the embodiment of the phrase "small is beautiful," showcasing that bigger isn't always better, and that compact, community-centric care can be just as powerful as large-scale medical facilities.
Small hospitals are the backbone of India's healthcare system, providing personalized care, and human touch, in a world where technology and automation often dominate.
In a country where healthcare is a fundamental right, small hospitals are the guardians of this right, ensuring that quality medical care reaches every nook and corner, and that no one is left behind."
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